When it comes to medical billing, there are two options: in-house billing and outsourced billing. The question is which one is right for your specific radiology group. With reimbursement shrinking, radiologists must weigh the pros and cons of both options.

In-house billing

In-house medical billing has advantages and challenges. Well-trained coding teams are often efficient, profitable, and emotionally connected to the practice. Even with the challenges associated with in-house billing, many radiology groups choose to continue using this billing option.

Advantages

• A sense of control: By continuing to have billing done in house, radiologists are able to influence the billing process. If there is a particular patient or aspect of the process that needs to be handled differently, it can easily be taken care of. This also includes having control over the collection process and being able to change it as needed.
• Loyalty to employees and accounts: The individuals who work on in-house billing quickly become an integral part of the office environment, developing relationships with the radiologists and other office staff. Their loyalty to the job and the practice is apparent. This loyalty shows in their dedication to the accounts they process, treating them as their own.
• Community support: In-house billing creates employment opportunities within the community, which will affect the area in a favorable way.

Disadvantages

The billing-services environment has drastically changed over the years, presenting new challenges for in-house billing groups. Some of the disadvantages are as follows:

• Cost: The cost of providing the appropriate billing services continues to rise. Some contributing factors to this rise are labor costs, employee benefits, system maintenance to both hardware and software, postage costs, and supplies.
• Additional steps: New steps and processes in billing have created additional costs as well. The rate of changes to the billing process by payors makes it challenging for in-house billing teams to stay informed and in compliance. Coding for CPT and ICD-9-CM also adds to the steps teams must take. Soon, coding teams will have to transition to ICD-10-CM, challenging even the most efficient teams.
• Exposure to risks: In-house billing also increases exposure to risks, including compliance and audit risks. By keeping billing in house, the billing team is tasked with staying current with the changes and requirements of the evolving industry.
• Managing billing personnel: By choosing to do billing in house, radiologists face many challenges when it comes to billing personnel. Recruiting qualified coding team members, team leaders, and managers is a difficult task and often takes time.
• Loss of key personnel: The biggest risk associated with in-house billing personnel is loss of a key team member who holds the practice leadership position and oversees the practice operations. Because everyone on the team looks to this leader for guidance, the practice could be left at a serious deficit without him or her.

With the challenges and risks associated with in-house billing, it is up to the radiologist to determine if the risks are greater than the rewards. Systems, software, billing requirements, coding assignments, reporting requirements, and compliance regulations all change, and determining what a group is willing to provide and what they're willing to absorb as risk is essential.

Outsourced billing

If the challenges of in-house billing become too much or aspects of the billing process are missing, it may be time to consider an outsourced billing company. Outsourced billing can provide the missing aspects at a potentially lower cost and lower risk. The decision to outsource medical billing can be a complicated one, but it can be extremely beneficial for radiology groups in the long run.

When considering whether to outsource to a billing company, radiology groups should consider all aspects of the billing process, as described below.

Knowledge/expertise

To provide radiology groups with peace of mind, it is essential that there is some assurance that the company has knowledgeable people involved in billing. Ensure that they are experts in the billing process. Make sure they are equipped to perform the duties they say they can, and be sure major areas of risk are covered with knowledgeable resources. Experience has no substitute; ask your prospects for references and take the time to call them. Ask the tough questions to ensure you're making the best decision for your practice.

Cost

There is a price to pay for billing services, and for radiology groups, it is important to consider the services purchased and what to expect from those services. Because not all billing services are the same, it pays to contact multiple companies to bid for your billing needs. It's not as simple as choosing the lowest bidder, because they will not necessarily cost you less. Choosing the cheapest service could cost you more in other ways, including uncollected funds, incorrectly coded procedures, wrong diagnoses, and areas of compliance being violated -- knowingly or unknowingly.

Typically, there are also additional costs associated with covering risk areas appropriately. Ask questions about the services they provide, and talk to other physicians and managers who use their services to see if the answers match up. Keep in mind that not every radiology group's needs are the same.

Trust

Part of the reason radiology groups keep their billing in house is because of the control and trust formed with billing associates. Therefore, it is important to trust the representatives from an outsourced billing company. This task is not necessarily easy, but knowing that the company will represent your group well, is knowledgeable, and will listen to any questions or concerns is extremely important.

Communication

There is value in being heard. With in-house billing, radiologists have direct input into the billing process, but when an outsourced company is used, there is little direct involvement in the process. However, if radiologists know there is a mechanism to voice questions or additional input, the transition from in-house billing to an outsourced company becomes a little easier.

Because medical billing is integral to the success of every radiology group, choosing the right type of billing services for your specific group is extremely important. Be sure to account for all aspects of the billing process, ensuring that each aspect is covered adequately. Even if things appear to be going well with your current billing system, it is still in your best interests to periodically review all steps of the billing process. By doing this, it will be easier to choose the best billing option for your company's needs.

John Stiles is a principal at HealthPro Medical Billing in Lima, OH, as well as the company's compliance officer and director of information services. A former insurance actuary with more than 30 years of experience in medical billing and physician practice management, John joined HealthPro in 1981 and is active in the Radiology Business Management Association (RBMA), the Healthcare Billing and Management Association (HBMA), and the Medical Group Management Association (MGMA).

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